STATE OF HAWAI'ICASE NUMBER

FAMILY COURT COMPLAINT FOR DIVORCEFIRST CIRCUIT FC-D NO.

This document is prepared byo Plaintiff o Attorney for Plaintiff

PLAINTIFF(Your Full Name) Name

VS.Address

DEFENDANTCity, State, Zip

(Your Spouse's Full Name) Phone

I, the Plaintiff, in support of this Complaint for Divorce, allege:

I. Jurisdiction:I and/or my spouse, the Defendant, have lived or have heen physically present in the State ofHawai'i for a continuous period ofatleast six (6) months and I have lived and/or been physically present on the Island ofO'ahu for a continuous period ofat least three(3) months immediately preceding this application.

2. Marriage:The parties (plaintiff and spouse) are lawfully married to each other.

3. Children:a. 0 The parties have no children together.b. 0 The parties have__ (enter number) child(ren) under 18 together.c. 0 The parties have__ (enter number) child(ren) 18 or older together, who are dependent on them for support.d. 0 The parties have__ (enter number) child(ren) 18 or older together, who are not dependent on them for support.e. 0 Wife has __ (enter number) child(ren) born during the marriage, not fathered by Husband.f. 0 Wife is pregnant.

4. Custody and Visitation:a. Legal custody of the minor child(ren) should be awarded to:

o Me, Plaintiff 0 My spouse, Defendant 0 Both parties jointlyb. Physical custody of the minor child(ren) should be awarded to:

o Me, Plaintiff 0 My spouse, Defendant 0 Both parties jointlyc. The parent not awarded physical custody should have:

o Reasonable visitation 0 SupeIVised visitation 0d. Child support should be awarded in accordance with the child support guidelines.

5. Division ofAssets:All assets my spouse and I own should be divided in a just and equitable way.

6. Division of Debts:All debts my spouse and lowe should be divided in a just and equitable way.

7. Spousal Support (Alimony):a. 0 I am entitled to an order that my spouse pay spousal support (alimony) to me.b.O My spouse 0 is o is not entitled to an order that I pay spousal support (alimony) to him/her.

8. Grounds:Pursuant to HRS Section 580-41, I allege that the grounds for divorce are as follows (check one only):a. 0 The marriage is irretrievably broken.b.O The parties have lived separate and apart for a period of two (2) or more years under a decree ofseparation from bed and board

or under a decree of separate maintenance.c. 0 The parties have lived separate and apart for a continuous period of two (2) or more years

immediately preceding the application, there is no reasonable likelihood that cohabitationwill be resumed, and it would not be harsh and oppressive to Defendant, or contrary to thepublic interest, to grant a divorce on this ground on the complaint of Plaintiff.

It is requested of the Court:That a decree be entered granting a divorce from the bonds of matrimony and granting the reliefrequested above, all as alleged and as may be appropriate and in accordance with the evidence and thelaw, and other relief as the Court deems proper in this case.

I declare, under penalty of perjury, that the statements made herein are true and correct to thebest of my knowledge, information and belief.

DATE PLAINTIFFS SIGNATURE

12f97 COMPLAINT FOR DIVORCE 1F-P·163

STATE OF HAWAI'I CASE NUMBER

FAMILY COURT SUMMONS

FIRST CIRCUITTO ANSWER COMPLAINT FC-D NO.

This document is prepared byo Plaintiff 0 Atty. for Plaintiff

PLAINTIFF(Full Name) Name

VS.Address

DEFENDANTCity, State, Zip

(Spouse's Full Name) Phone

TO THE DEFENDANT

You are hereby summoned and required to serve a written answer to the attached Complaint within 20 days after service ofthis Summons upon you, exclusive of the date afservice.

Your written answer must be filed with the Chief Clerk ofthis Circuit at the following location or address.

Kapolei Court Complex or Ka<ahumanu Hale4675 Kapolei Parkway 777 Punchbowl StKapolei, HI 96707-3272 Hon., HI 96813

A copy ofyollr answer should also be served upon the Plaintiffs attorney, or in the event Plaintiff is not represented by anattorney, upon the Plaintiff at the address shown on the Complaint.

If you fail to file your written answer within the 20-day time limit, further- action may be taken in this case, includingjudgment for the relief demanded in the Complaint, without further notice to you.

THIS SUMMONS SHALL NOT BE PERSONALLY DELIVERED BETWEEN 10:00 P.M. AND 6:00 A.M. ONPREMISES NOT OPEN TO THE PUBLIC, UNLESS A JUDGE OF THE DISTRICT OR CIRCUIT COURTSPERMITS, IN WRITING ON THE SUMMONS, PERSONAL DELIVERY DURING THOSE HOURS.

FAILURE TO OBEY THE SUMMONS MAY RESULT IN AN ENTRY OF A DEFAULT AND DEFAULTJUDGMENT AGAINST THE PERSON SUMMONED.

DATE CLERK OF COURT

-FORM NO. 073921 12/97 SUMMONS TO ANSWER COMPLAINT 1F,P-064

•

In accordance with the Americans with DisabilitiesAct and other applicable state and federal laws, ifyou require a reasonable accommodationfor a disability. please contact the ADA Coordinator at the Deputy Chief Court Administration Office at PHONE NO. 954-8200. FAX 954-8308.or TTY 539-4853, at leasUen (10) working days prior to your hearing or appointment date.

STATE OF HAWAI'I CASE NUMBER

MATRIMONIAL ACTIONFAMILY COURT FC-D NO.FIRST CIRCUIT INFORMATION

PLAINTIFF PREPARED: DATE FILEDo PLAINTIFFo DEFENDANT

DEFENDANTo ATTORNEY FOR PLAINTIFFo ATTORNEY FOR DEFENDANT

NATURE OF CASE

o DIVORCE o SEPARATION o ANNULMENT o OTHER

ITEM WIFE HUSBAND

FULL NAME

BIRTH OR MAIDEN NAME

ADDRESSSTREET, APT. NO.

TOWN, STATE, ZIPCOUNTY

HOME WORK HOME WORK

PHONE

SOCIAL SECURITY NUMBER

DATE OF BIRTH

PLACE OF BIRTH (State or Country)

RACE

HIGHEST GRADE COMPLETED

HAWAII RESIDENT SINCE

CIRCUIT RESIDENT SINCE

PRIMARY EMPLOYER

(Name and Address)

JOB TITLE

WORK SCHEDULE

LENGTH OF SERVICE

Primary Secondary Welfare Primary Secondary Welfare

GROSS MONTHLY INCOME(All Sources)

DATE OF THIS MARRIAGEDATE COUNTY I STATE

DATE OF SEPARATION DATE COUNTY I STATEo NOT SEPARATED

Form No. 073105 R12f97 (Continue on back page) MATRIMONIAL ACTION INFORMATION 1F·P.Q82

MATRIMONIAL ACTION INFORMATION (Continued) CASE NUMBER

FC-D NO.

FROM TO TERMINATED BY STATEMONTHIYEAR MONTHIYEAR DIVORCE ANNULMENT DEATH

WIFE'S PRIOR

MARRIAGES

HUSBAND'S PRIOR

MARRIAGES

CHILDREN: ALL CHILDREN OF EITHER PARTY FROM YOUNGEST TO OLDEST

CHILO'S FULL NAME M/F BIRTHDATELEGAL I PRESENT

SCHOOL AND GRADE,~~~~~I,~ W 'F CUSTODY

INFORMATION REQUIRED FOR CUSTODY

CHILDREN'S PRESENT ADDRESS:

PLACES WHERE AND PERSONS WITH WHOM THE CHILDREN HAVE LIVED WITHIN THE LAST FIVE YEARS AND DATES

ADDRESS CARETAKERS FROM TOMONTHIYEAR MONTHIYEAR

WIFE 0 IS 0 IS NOT PREGNANT. EXPECTED DELIVERY DATE:

THE UNDERSIGNED SOLEMNLY AND SINCERELY DECLARES, UNDER PENALTY OF PERJURY, THAT THE STATEMENTS MADE HEREIN ARETRUE AND CORRECT TO THE BEST OF HIS/HER KNOWLEDGE, INFORMATION AND BELIEF.

DATE SIGNATURE

STATE OF HAWAI'I NOTICE TO ATTENDCASE NUMBER

FAMILY COURT FC-D NO.FIRST CIRCUIT KIDS FIRST

PLAINTIFF ATTORN EY (Name. Address. and Telephone Number)

Name: D Plaintiff Pro Se

Address:

Telephone: (home)

(work) (Staff Use Only)

Cellular: Date Attended:

DEFENDANT ATTORN EY (Name, Address, and Telephone Number)

Name: D Defendant Pro Se

Address:

Telephone: (home)

(work) (Staff Use Only)

Cellular: Date Attended:

DO NOT BRING CHILDREN UNDER THE AGE OF 6 YEARS OLDCHILDREN: List all children ages 6 to 17 years old from this and any other relationship:

(STAFF USE ONLY)Name Birthdate and Age Living With: Date Attended

D Plaintiff D Defendant D Other

D Plaintiff D Defendant D Other

D Plaintiff D Defendant D Other

D Plaintiff D Defendant D Other

D Plaintiff D Defendant D Other

NOTE: Plaintiff and Defendant must attend. Children, ages 6-17, who have lived as a family withthis Plaintiff and Defendant must attend.

Choose one location only:

D KAPOLEI D HONOLULUTime: 5:00 p.m. Registration Time: 5:00 p.m. Registration

5:30 p.m. - 7:30 p.m. Program 5:30 p.m. - 7:30 p.m. Program

Place: Kapolei Court Complex Place: Circuit Court, Jury Pool Lounge4675 Kapolei Parkway 777 Punchbowl Street, Honolulu

Date: Wednesday, Date: Wednesday,

DATE CLERK'S SIGNATURE

Reprographics (03/10) 1F Page 1 of2 1F-E-787 FCAdm 2/22110

KIDS FIRST INSTRUCTIONS

KIDS FIRST is a program designed to help parents understand the effects of separation anddivorce on their children and to help children cope with changes in their families. BOTHparents must attend. Children (ages 6-17) of either Plaintiff or Defendant, from this and anyother relationship who have lived with Plaintiff's and Defendant's currentfamily must attendKids First, unless excused by the Judge.

Failure to attend may cause you to be brought before the Court to explain your non­attendance and may be considered as a factor in custody decisions. Non-attendance mayalso delay the granting of your divorce decree.

You and your children will watch a video. Parents will have their own program presented bypsychologists who specialize in paternity and divorce. The children and teens will begrouped by age and led by trained facilitators. Theywill play games, see the courtroom, roleplay; and may express their feelings about the divorce.

DO NOT BRING CHILDREN UNDER AGE 6 or any child not listed on page 1 of this notice.Babies and minor children are not allowed in the parents' program. If you bring a child underage 6, you will be required to reschedule to another day.

KAPOLEI COURT COMPLEXMetered Parking is available.Enter through the front door at 4675 Kapolei Parkway.

CIRCUIT COURT (HONOLULU)Parking is available at Restaurant Row at a reduced rate with validation.Caution: Halekauwila Street, makai side (ocean side), is a tow-away zone.Enter through the front door at 777 Punchbowl Street.

You must call (808) 954-8280 if any of the following apply:~ Restraining Order~ Moving off island~ Child Protective Service Case~ Child with special needs (physical, mental, language difficulties)~ You received this notice after your scheduled date~ If you require an interpreter~ Any scheduling questions

Leave your name, daytime telephone/cellular phone number and a detailedmessage on this recording. Your call will be returned as soon as possible.

a In accordance with the.Americans with Disablhties Act and other applicable state and federal laws, If you require a reasonable accommodation for a disability,please contacllhe ADA Coordinator al the Office aftha Chief Admlnislralorat PHONE NO. 954-8200, FAX 954-8308, orTlY 539-4853 at leasllen (10) workingdays prior 10 your heanng or appointment date.

Reprographics (03/10) 1F Page2of2 1F·E·787 FCAdm 2122/10

STATE OF HAWAI'I MOTION FOR SERVICE BY MAIL CASE NUMBER

FAMILY COURT AND AFFIDAVIT;FIRST CIRCUIT ORDER FOR SERVICE BY MAIL FC-D NO.

This document is prepared by

D Plaintiff D Ally for Piaintiff

PLAINTIFF(Your Full Name) Name

Address

V5.

City. State, Zip Code

DEFENDANT(Your Spouse's Full Name) Telephone No.

MOTION FOR SERVICE BY MAIL AND AFFIDAVIT

The undersigned party to this action for an order authorizing service by registered or certified mail. In support ofthis motionthe undersigned states that to hislher best information and belief the adverse party is outside the Circuit and receives mail atthe following address:

I IMOVANT'S SIGNATURE

DocumentTitle: Motion for Service by Mail and Affidavit Document Date: No. of Pages: ___

was subscribed and sworn to before me in the First Circuit, State of Hawai'i, by

Notary Public's Signature: Date:L.S. (Seal)

Print Notary Public's Name:

My commission expires:

ORDER FOR SERVICE BY MAIL

It appears that service by mail is appropriate and reasonable. IT IS HEREBY ORDERED that service herein may be made byforwarding certified copies of the

D Complaint D Summons D Motion and Affidavit for Pre-Decree Relief and AttachmentsD Motion and Affidavit for Post-Decree Relief and Attachments

D Income and Expense Statement; Asset and Debt Statement

Dand of this Order to the DPlaintiff D Defendant by registered or certified mail withreturn receipt requested and a direction to deliver to addressee only and that actual receipt

by the DPlaintiff D Defendant ofthe above document(s) sent in accordance with this

Order shall be equivalent to personal service by an authorized process server as ofthe date

process server as of the date of receipt.DATE JUDGE'S SIGNATURE:

PRINT JUDGE'S NAME: (Court Use Oniy)FORM NO. 073922 (12/97; FCAdm 4116/10) MOTION FOR SERVICE BY MAIL AND AFFIDAVIT; ORDER FOR SERVICE BY MAIL 1F-P-186

STATE OF HAWAI'I CASE NUMBER

FAMILY COURT APPEARANCE AND WAIVERFIRST CIRCUIT FC-D NO.

This document is prepared byo Plaintiff o Defendant o Atty. for Plaintiff o Atty. for Defendant

PLAINTIFF(Full Name) Name

VS.Address

DEFENDANTCity, State, Zip

(Full Name) Phone

I, the Defendant, acknowledge receipt of a filed copy of the Complaint and Summons in the above-entitledaction, submit myself to the Court's jurisdiction, and have agreed with the Plaintiff on the matters set forth in

0 a signed agreement incident to divorce.0 a form of Decree which I have approved by signature.

I consent to a hearing of the complaint by ajudge at any time without further notice and without my presenceso long as the Decree issued incorporates the provisions I have approved. If such Decree is not entered by theCourt, I request to be notified.

I understand that I am not required to sign this paper and that by doing so I am permitting the Court withoutopposition from me to proceed with the above-entitled matter at this time unless there is reason for the Court toalter our agreement.

0 I am not in the military service of the United States.0 I am in the military service ofthe United States, but I do not request a stay ofproceedings herein, and I do

waive any rights I may have under the Soldiers' and Sailors' Civil Relief Act, 50 U.S.C. Sec. 521, et.~.

DATE DEFENDANT'S SIGNATURE

12/97 APPEARANCE AND WAIVER 1F·P-332

PROOF CASE NUMBERSTATE OF HAWAI'I

FAMILY COURT OFFC-O NO.

FIRST CIRCUIT SERVICE

This document is prepared byo Plaintiff 0 Attorney for Plaintiff

PLAINTIFF(Full Name) Name

VS.Address

DEFENDANT City, State, ZiP

(Full Name) phone

I served a certified copy of each document identified below by delivering to the following person(s):

PERSONtS\SERVED DATE TIME PLACE

DOCUMENTS SERVED

o Complaint o Summons o Notice to Attend Kids First II

o Motion and Affidavit for Pre-Decree Relief and Attachements

o Motion and Affidavit for Post-Decree Relief and Attachments

0

PLEASE EXPEDITE RETURN OF SERVICE TO FAMILY COURT

DATE POLICE OFFICER'S SIGNATURE BADGE ID NUMBER

DATE OTHER SERVING OFFICER·S SIGNATURE NAME OF SERVING OFFICER

o UNSERVED DOCUMENTS: I certifY that, despite due and diligent search, I was unable tolocate the person to be served, and therefore the attached documents are being returned asunserved.

FORM NO. 073918 (12198) PROOF OF SERVICE1F·P·140

STATE OF HAWAI'I CASE NUMBER

FAMILY COURT STATEMENT OF MAILINGFIRST CIRCUIT EXHIBITS "1" AND "2" FC-D NO.

This document is prepared byo Plaintiff 0 Atty. for Plaintiff

PLAINTIFF(FUll Name) Name

VS.Address

DEFENDANTCity, Slate, Zip

(FUll Name) Phone

STATEMENT OF MAILING

I REPRESENT THAT I caused one certified copy each of the Complaint For Divorce; Summons to AnswerComplaint; and Motion for Service by Mail and Affidavit; Order for Service by Mail; and

, to be mailed by certified or registered mail, return receipt requested,restricted delivery to:

Defendant S Name

Defendant's Address

City/State/ZIp

Defendant

At the time of mailing, the receipt attached hereto as Exhibit" I" was postmarked and dated. Thereafter, thereturn receipt attached as Exhibit "2" was received.

DATE PLAINTIFF'S SIGNATURE

4/98 STATEMENT OF MAILING/EXHIBITS "1" AND "2"

1F.p-3XX

EXHIBIT "1" EXHIBIT "2"

STATE OF HAWAI'I CASE NUMBERINCOME AND EXPENSE STATEMENT

FAMILY COURT o Plaintiff o DefendantFIRST CIRCUIT FC-D NO.

This document is prepared byo Plaintiff o Defendant o Atty. for Plaintiff o Atty. for Defendant

PLAiNTIFF(Full Name) Name

V8.Address

DEFENDANTCity, State, Zip

(Full Name) Phone

Occupation:Job title

Employer:

Address:

Length ofservice: months/years.

Income Tax Withholding based on: dependents.

INCOME

Gross income. Paid: D monthly, D 2 times per month, D every 2 weeks, D weekly D or other

Gross per pay period ...................................... $ Per month ............................... $

Payroll deductions per pay period:

Fed. income tax ....................................... $State income tax ...................................... $FICA (Social Security) ............................ $Union dues .............................................. $

a) Net per pay period ................... $ Per month ........ $

Other:Retirement/40lK ................................... $Credit Union .......................................... $Direct Deposit ....................................... $Income Assignments .............................. $Support Payments .................................. $Medical Insurance ................................. $

b) Take home per pay period ....... $ Per month ........ $

Other regular monthly income, (rental income, 2nd job, interest, child support, welfare, foodstamps, and any other source.)

Gross monthly receipt ............................. $Taxes paid IRS and State on above .......... $

c) Total other income net ............................... $

Total Monthly Income (Add per month income from lines a and c above) $

FORM NO. 013917 R12197 INCOME & EXPENSE STATEMENT 1F·P-6S1

EXPENSES

Do not list expenses which are paid by payroll deduction.

Housing, expenses per month:rent, mortgage, agreement of sale ................................ $insurance ifnot included above .................................... $Real Property taxes (ifpaid separately) ........................ $Utilities, gas, water, elec., telephone etc....................... $

Transportation, expenses per month:Car payment, lease, rental ............................................ $Insurance on vehicle .................................................... $Maintenance (repairs) .................................................. $Operating (gas, oil & tires) .......................................... $

Total Housing and Transportation expenses ..................................................................................... $

Debt service (all monthly payments, ego credit cards, charges, finance company, personal loans) ...... $

Personal Expenses per month: Self Children No.( - )Food ............................................................................... $ $Clothing ......................................................................... $ $Medical and Dental ........................................................ $ $Laundry & Cleaning ....................................................... $ $Personal articles ............................................................. $ $Recreation (movies etc) .................................................. $ $School (include food) ..................................................... $ $Household ...................................................................... $ $Bus (on monthly basis) ................................................... $ $Other ( ) .................................. $ $Payment to others for dependent care ......................................................... $

Sub Totals .......................................................... $ $

Total Personal expenses ................................................................................ $

Grand Total expenses: Housing, Trans., Debt & personal .......................................................... $

Savings, <Deficiency>: Income minus Expenses ....................................................................... $

Explain in detail where savings are invested, or if there is a <deficiency>, who provides the funds to maintainthe level of spending indicated in this income and expense statement. (Use separate sheet if more space is needed.)

.

CERTIFICATION

I hereby declare under the penalty of peJjury that I have supplied the infonnation used in this Income and ExpenseStatement and have reviewed this statement and I certifY that the infonnation is accurate, complete and correct.

DATE 0 PLAINTIFFS 0 DEFENDANT'S SIGNATURE

FORM NO. 073917 R12197 INCOME & EXPENSE STATEMENT 1F.p-081

STATE OF HAWAI'I CASE NUMBER

FAMILY COURT ASSET AND DEBT STATEMENT

FIRST CIRCUIT o Plaintiff 0 Defendant 0 Both Parties FC-D NO.

This document is prepared byo Plaintiff o Defendant o Atty. for Plaintiff o Atty. for Defendant

PLAINTIFF(Full Name) Name

V8.Address

DEFENDANTCity, State, Zip

(Full Name). Phone

l. Cash (on hand or held by others for me) $

2. CREDIT UNION ACCOUNTS:

Name Title (H,W,J) Credit Balance Debt Balance--

3. BANK AND SAVINGS ACCOUNTS: (Include Trustee Accounts)

Company & Branch Type of Account Title (H,W,J) Current Balance

4. SECURITIES: (Stocks, Bonds, Mutual Funds, Certificates ofDeposit, etc.)

Company Title (H,W,J) Date of Acquisition Cost Market Value Debt Owed Against-

Form No. 073925 R12/97 ASSET AND DEBT STATEMENT 1F.p-Q63

Page 2

5. VEHICLES: (Autos, Trucks, Motorcycles, Trailers, Campers, Boats, etc.)

Year

6. REAL PROPERTY:

Make Title (H.W,J) Currrent Market Value Debt Owed Against

Address Fee or Lease Title (H,W,J)Date of

Acquisition CostCurrent

Gross ValueTotal

Debt Owed

7. LIFE INSURANCE:

Company Person Insured Face Amount BeneficiaryTitle

(H,W,J) Cash ValueDebt Owed

Against

8. RETIREMENT; PENSION; PROFIT SHARING ACCOUNTS:

Employer or Company Title (H,W,J) Type of Plan Years in PlanTotalValue

9. ALL OTHER MAJOR ASSETS: (Furniture, Household Effects, Art, Stamps, Coins, Tools,Equipment, Jewelry, Accounts Receivable,. Investment Assets, Business Assets, Cemetary Plots orNiches, Tax Refunds Due, etc.)

General Description

Form No. 073925 R12/97

Title (H,W,J) Estimated Gross Value Debt Owed Against

ASSET AND DEBT STATEMENT 1F-p-063

Page 3

10. PROPERTY HELD IN TRUST FOR OR BY THIRD PERSON/S: (Aside from Bank & SavingsAccounts Noted in paragraph 3)

Description Trusteels Beneficiaries Value Debt Owed Against--

II. ALL OUTSTANDING DEBTS: (Include those listed parts in 2, 4, 5, 6, 7, 9, and 10 above, inaddition to all credit cards, charges, fmance companies, and personal loans.)

Debtor Mo./Yr. Total Minimum MonthlyCreditor (H,W,J or Other) Security Debt Incurred Balance Owed Payment---

Total Debt in Wife's Name Alone:

Total Debt in Husband's Name Alone:

Total Debt in Joint Names:

CERTIFICATION

I hereby declare under the penalty of perjury that I have supplied the information used in this Asset andDebt Statement and have reviewed this statement and I certify that the information is accurate, completeand correct.

DATE o PLAINTIFF'S 0 DEFENDANT'S SIGNATURE

DATE o PLAINTIFF'S 0 DEFENDANT'S SIGNATURE

Form No. 073925 R12197 ASSE.T AND DEBT STATEMENT 1F.p-063

STATE OF HAWAI'I CASE NUMBER

FAMILY COURT AFFIDAVIT OF PLAINTIFFFIRST CIRCUIT (FOR UNCONTESTED DIVORCE) FC-D NO.

This document is prepared byo Plaintiff o Atty. for Plaintiff

PLAINTIFF(Your Full Name) Name

Vs.Address

DEFENDANTCity, State, Zip

(Your Spouse's Full Name) Phone

STATE OF HAWAI'I )) SS.

CITY AND COUNTY OF HONOLULU )

Plaintiff in the above-entitled action, being first duly sworn on oath, deposes and says that:

I. Plaintiff's full name and address is;

2. Legal Representation;2a. 0 Plaintiff is representing him/herself.2b. 0 Plaintiff is represented by the attorney named above.

3. Service ofprocess on Defendant was made by;3a.D Personal Service: A Proof of Service or Affidavit of Service has been filed showing that the Defendant

was personally served with the Complaint and Summons on by a personauthorized to serve oflegal documents.

(MOJDayirr)

3b.D Certified or Registered Mail; The Complaint and Summons was served upon Defendant by certified orregistered mail. A Statement ofMailing or Affidavit ofMailing and an original return receipt signed by theDefendant on have been filed. Plaintiff recognizes Defendant's signature on the returnreceipt.

(MoiDayl'ir)

3c.D Appearance and Waiver: Defendant acknowledged receipt ofa filed copy of the Complaini and Summonsand signed an Appearance and Waiver on . Plaintiff recognizes Defendant'ssignature on the Appearance and Waiver. (MOJDayil'rj

3d. 0 Publication; The Affidavit ofPublication was filed on(MofUaylnj

4.0 Default.4a.D More than twenty (20) days have passed since the service of the Complaint

and Summons on the Defendant. No responsive pleading has been filed.Neither Plaintiff nor Plaintiff's attorney has received any communicationfrom Defendant or Defendant's attorney concerning this case since the Com-plaint was served.

4b.D An order granting the Motion for Entry of Default was filedon

(MOIDayih)

12198 AFFIDAVIT OF PLAINTIFF (UDA) 1F.p·333

STATE OF HAWAI'I AFFIDAVIT OF PLAINTIFF CASE NUMBER

FAMILY COURT (FOR UNCONTESTED DIVORCE)FIRST CIRCUIT PAGE TWO

FC-D NO.

5. Jurisdiction: (Check all that apply)Sa. 0 Plaintiffhad been domiciled or physically present on the Island ofO'ahu for a continuous period ofat least

3 months prior to the filing of the Complaint for Divorce.Sb.D Plaintiffhad been domiciled or physically present in the State ofHawai'i for a continuous period ofat least

6 months prior to the filing of the Complaint for Divorce.Sc.D Defendant had been domiciled or physically present in the State ofHawai'i for a continuous period of at

least 6 months prior to the filing of the Complaint for Divorce.

6. Defendant resides in (city, state) ,(CItY) (SUIte)

7. The parties were married on(MOJuayl'l'r)

8. The parties last lived together in (city, state) , on(CnY) (State)

(M{))DayiYr)

9. Plaintiff believes that the marriage is irretrievably broken because:

10. Financial statements:

I Oa. Plaintiff signed Income and Expense and Asset and Debt Statements on (MoiDayIYr). To thebest of Plaintiff's knowledge there have been no substantial changes in Plaintiff's financial circumstancessince that date.

lOb. 0 Defendant signed Income and Expense and Asset and Debt Statements onPlaintiff recognizes Defendant's signature on said documents. (MOJDayil'r)

IDe. 0 Defendant's Income and Expense Statement and Asset and Debt Statement are not filed because:

II. Plaintiff has carefully reviewed the proposed decree and agrees to the alimony, division of property and otherprovisions as provided in the proposed decree.

12. Plaintiff signed the proposed decree. 0 Plaintiff recognizes Defendant's signature on the decree.

13. Wife wishes to resume the use ofher 0 birth surname 0 former married name and be known as:

14. Husband wishes to resume the use of his 0 birth surname 0 former married name and be known as:

IS. Language Comprehension:ISa.D Plaintiff fully understands the English language.ISb.D Although Plaintiff does not fully comprehend written English, this document has been explained to him!

herby and based on that explanation Plaintiff understands this document.

16. Plaintiff requests that the court grant this divorce and enter the decree without hislher appearance in court.

17. Plaintiff has read this document and signs it voluntarily and without coercion and duress and not because he/shewas told to sign it.

12198 Page 2 of4 AFFIDAVIT OF PLAINTIFF (UDAl 1F-P-333

STATE OF HAWAI'I AFFIDAVIT OF PLAINTIFF CASE NUMBER

FAMILY COURT (FOR UNCONTESTED DIVORCE)FIRST CIRCUIT PAGE THREE

FC-D NO.

18. Pregnancy:18a.D Wife is not pregnant.18b.D Wife is pregnant and her expected date of delivery is . Husband 0 is 0 is not the father

of said child.(MOJDayil'r)

19. Child(ren):19a.D Plaintiffand Defendant have no children together.19b.D The parties have children together. The complete name and birthdate of each are listed as follows

from the oldest to the youngest child (including adult child(ren)):

Name Date of Birth

(MoJDaylYr)

(MoJDaylYr)

(MoIDayNr)

(MoJDayfYr)

(MoIDayfYr)

(MoIDaylYr)

19c.D There is/are child(ren) conceived during the marriage fathered by someone other than husband. Theirname(s) and date ofbirth is/are listed as follows:

Name Date of Birth Judgment ofPaternitv entered

(MofDaylYr) 0 Yes o No(MoIDayfYr) 0 Yes o No

20. Prior or Pending Custody Proceedings:20a.D I have not participated in any capacity in any law suit or proceeding in any state concerning custody ofany

ofthe minor children ofthe Plaintiffand Defendant together. I have no information ofany pending custodyproceeding or of any person not a party to this proceeding who has physical custody or claims to havecustody or visitation rights concerning any minor children of the Plaintiiffand Defendant together.

20b.D Prior court case involving the subject children:Case Name:Case Number:Location of Court:Date Filed: (MoJDaylYrl

Date Concluded: (MoIDayfYr)

Type of Case:20c.D Other court case involving the subject children which is still pending:

Case Name:Case Number:Location of Court:Date Filed: (MolDaylYr)

Date Concluded: (MoIDaylYr)

Type of Case:

12/98 Page 3 of 4 AFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333

STATE OF HAWAI'I AFFIDAVIT OF PLAINTIFF CASE NUMBER

FAMILY COURT (FOR UNCONTESTED DIVORCE)FIRST CIRCUIT PAGE FOUR

FC-D NO.

21. 0 Plaintiff agrees to the custody arrangement and child support amounts as provided in the proposed divorcedecree.

22. Child Support:22a.O Plaintiff believes that the infonnation provided in the completed Child Support Guildelines Worksheet is

accurate, to the best of the Plaintiff's knowledge and proposed child support is consistent with the ChildSupport Guidelines Worksheet.

22b.O Proposed child support varies from the Child Support Guidelines Worksheet because of the followingexceptional circumstances:

23. Kids First:23a.O I attended the Kids First II Program (Wednesday Night) on (MolDaylYr) .

23b.O I was excused by Judge from attending the Kids First II Program.

24.0 Other:

.

Plaintiff declares that he/she understands that his/her signature under oath before a notary public is hislher solemn statement that he/she read thisAffidavit and knows and understands the contents and that these statements are true, correct and complete to the best of his/her knowledge and belief.

PLAINTIFF'S SIGNATURE

SUBSCRIBED AND SWORN TO NOTARY PUBLIC'S SIGNATURE MY COMMISSION EXPIRES:BEFORE ME THIS DATE:

IN , Hawai'i STATE OF HAWAI'I

12/98 Page 4of4 AFFIDAVIT OF PLAINTIFF (UDAl 1F.p-333

FAMILY COURT SUPPLEMENTAL AFFIDAVIT CASE NUMBER

FIRST CIRCUIT RE: DIRECT PAYMENT FC-DNO.

STATE OF HAWAI'I CHILD SUPPORTPreparer's Name, Address and Telephone Number

PLAINTIFF,

vs.

DEFENDANT.

1. My spouse and I have agreed that I shall pay child support directly to my spouse and not through the ChildSupport Enforcement Agency (CSEA).

2. Such an arrangement is in the best interest of our child(ren) because:

3. [ ] I affirm that all prior child support, ordered by the court or administratively, has been paid in atimely fashion.[ ] I have not been previously ordered to pay child support.

4. Our child(ren) do/does not receive public assistance, welfare, foster care, Social Security or othergovernmental assistance.

5. There are no outstanding debts owed to the Department ofHuman Services or other public assistanceagencies by myself or my spouse.

6. I understand that at any time after the entry ofour Divorce Decree, either party may void the direct paymentarrangement and apply for services from the Child Support Enforcement Agency (CSEA) to receive paymentthrough the agency.

7. I further understand that if our child(ren) receive(s) public assistance from the Department ofHumanServices, foster care payments or Social Security or if either parent applies to the CSEA for services, CSEAmay irnmediately void the direct payment arrangement by sending written notice by regular mail to bothparents at their last known addresses as set forth in our Divorce Decree or subsequent child support order.

8. Based upon the facts set forth herein, I ask this Court to approve direct payments of child support rather thanrequiring that child support payments be made through the CSEA.

I declare that I understand that my signature under oath before a notary public is my solemn statement that I have readthis affidavit and I know and understand the contents and that the statem~nts are true, correct and complete to the best ofmy knowledge and belief. .

SIGNATURE

SUBSCRIBED AND SWORN TO NOTARY PUBLIC'S SIGNATURE MY COMMISSIONBEFORE ME ON THIS DATE: EXPIRES:

STATEOFHAWAI'IFOR COURT USE ONLY

dirpay.aff - 11/98

STATE OF HAWAI'I CASE NUMBER

FAMILY COURT DIVORCE DECREEFIRST CIRCUIT (With Children) FC-D NO.

This document is prepared byo Plaintiff o Defendant o Atty. for Plaintiff o Atty. for Defendant

PLAINTIFF(Full Name) Name

V8.Address

DEFENDANTCity, State, Zip

(Full Name) Phone

Presiding Judge Date of Hearing/Review by Judge

A hearing was held before the Presiding Judge or an affidavit was submitted and the Court waived hearing on this matter. Afterfull consideration ofthe evidence, the Court finds the material allegations ofthe Complaint for Divorce to be true. Plaintiffis entitledto a divorce from the bonds ofmatrimony. The Court has jurisdiction to enter this Divorce Decree. In this Divorce Decree, Plaintiffis referred to as 0 Husband 0 Wife, and Defendant is referred to as 0 Husband 0 Wife.

IT IS HEREBY ORDERED, ADJUDGED AND DECREED that:

1. Decree: A decree ofdivorce is granted to 0 Husband 0 Wife. The bonds ofmatrimony between Husband and Wife are herebydissolved. The parties are restored to the status ofsingle persons. Either party is pennitted to marry after the effective date ofthisDivorce Decree.

2. Effective Date: This Divorce Decree is effective afier it is signed and filed by the Court.

3. Alimony:o 3A. Neither party shall be required to pay alimony to the other party.o 3B. Beginning with a first payment on the __ day of (MonthfYear)

o Husband 0 Wife shall pay to 0 Husband 0 Wife alimony of $ per month, to be paido in one amount of$ by the __ day of each month.o in two equal installments of $ bythe __ and days of each month.

Alimony shall continue for __ months and terminate with the payment due (MolDaylYr) •

Alimony shall terminate upon the death of either Husband or Wife.·Alimony 0 shall 0 shall not terminate upon the recipient's remarriage.

4. The parties have __ child(ren) together:

Name lfirst middle, lasll Date of Birth

5. Custody:SA. Legal Custody of the above-named minor child(ren) is:

o Awarded to Husbando Awarded to Wifeo Awarded to Husband and Wife,jointly.o Reserved for a court of competent jurisdiction.

FORM NO. 073106 8/98 (Page 1)DIVORCE DECREE (WITH CHilDREN) 1F·P-096

5B. Physical Custody of the above-named minor child(ren) is:D Awarded to Husband with a detailed visitation/time sharing schedule to Wife as described in paragraph 6.D Awarded to Wife with a detailed visitation/time sharing schedule to Husband as described paragraph 6.o Awarded to Husband and Wife, jointly, with a visitation/time sharing schedule as described in paragraph 6B below.o Reserved for a court of competent jurisdiction.

6. VisitationlTime Sharing Schedule shall be as follows:o 6A. The parties shall arrange reasonable visitation.D 6B. Visitation/time sharing schedule shall be as follows: _

D 6C. Supervised visitation: _

o 6D. There shall be no visitation until further order of the Family Court.

7. l&l Unless specified in paragraph 24 ofthis decree, Husband and Wife shall keep each other infonned ofhis/her residence addressand telephone number for so long as any child ofthe parties is a minor and for so long thereafter as there is a support order.

8. Child Support:D 8A. Beginning with the first payment on the day of:-:-__:-= ~, Husband shall pay to Wife for the

support of the parties' child(ren) $ per child, for a total of$ per month.D 8B. Beginning with the first payment on the day of , Wife shall pay to Husband for the

support of the parties' child(ren) $ per child, for a total of$ per month.D 8C. Child support is reserved for a court of competent jurisdiction.I8J 8D. Payments ofchild support shall continue for each child until the child attains the age ofeighteen years, or graduates from

high school, or discontinues high school, whichever occurs last. Child support shall further continue uninterrupted(including during regular school vacation periods) until the age of23 as long as the child continues his or her educationpost-high school on a full-time basis at an accredited college or university or in a vocational or trade school.

I8J 8E. The Child Support Enforcement Agency (CSEA) is made a party for the limited issue of child support.

9. Method of Child Support Payment ( Check either 9a OR 9b):D 9A. All payments shall be made payable to and through the Child Support Enforcement Agency (CSEA), P.O. Box 1860,

Honolulu, Hawai'i 96805-1860, and pursuant to the Order oflncome Withholding which shall be filed with this decree.D 9B. Direct Payment

D Child support payments shall be paid by Husband directly to Wife.D Child support payments shall be paid by Wife directly to Husband.

1111 In all direct payment cases, either Husband or Wife may void the direct payment arrangement at any time and applyfor services from the CSEA to receive payments through the agency. lfthe child(ren) of the parties receive(s) publicassistance from the Department ofHuman Services, foster care payments or Social Security or ifeither parent appliesto the CSEA, CSEA may immediately void a direct payment arrangement by sending notice by regular mail to bothparents at their last known addresses as set forth in this Divorce Decree.

10. Post-High School Education Support:D lOA. Husband shall pay __% and Wife shall pay __% of the educational expenses of the child(ren) for so long as the

child(ren) is/are a full-time student at an accredited college or university or vocational or trade school and under the ageof23.

FORM NO. 073106 8198(Pag,2)

DIVORCE DECREE (WITH CHILDREN) 1F·P-D96

D lOB. For payment of expenses related to the child(ren) attending private school see paragraph 24 below.\1>l1 DC. For these purposes, educational expenses shal! be defined to include tuition, fees and the costs ofnecessary books and other

course materials.

11. Child Health Care: For so long as Husband or Wife has an obligation to pay child support andlor educational support:D II A. Husband shal! maintain medical and dental insurance for the benefit of the child(ren).o liB. Wife shall maintain medical and dental insurance for the benefit of the child(ren).D II C. Husband shal! pay the medical and dental expenses of the child(ren) not paid by insurance up to $,-,---_---,-,.,--,.,-----,_--,

per calendar year. Any additional medical and dental expenses not covered by insurance shall be paid__%by Husbandand __ % by Wife.

D lID. Wife shal! pay the medical and dental expenses ofthe child(ren) not paid by insurance up to $ percalendar year. Any additional medical and dental expenses not covered by insurance shall he paid __ % by Husbandand __ % by Wife.

12. Life Insurance for the Benefit of Child(ren):D12A. Husband shal! maintain life insurance on his life with a minimum death benefit of$ for the benefit of the

child(ren) so long as there is a child support andlor educational support obligation.D 12B. Wife shal! maintain life insurance on her life with a minimum death benefit of $ for the benefit of the

child(ren) so long as there is a child support and/or educational support obligation.~ 12C. IfHusband or Wife dies without the required insurance, Husband's or Wife's estate shal! be liable to the child(ren) to the

extent that the required insurance was not maintained. Such obligation on the part ofHusband's or Wife's estate shall beaccorded the highest possible priority.

13. IZl All provisions in paragraphs 3, 5, 6, 7, 8, 9, 10, 11 and 12 are subject to further order of the court.

14. Bank Savings, Checking, Credit Union Accounts and Securities (Stocks, Bonds, Mutual Funds, etc.):D 14A. There are none.D 14B. Each is awarded those titled in their name alone.D 14C. Husband is awarded: _

DI4D. Wife is awarded: _

15. Vehicles (Autos, Trucks, Motorcycles, Trailers, Campers, Boats, etc.):D 15A. There are none.D 15B. Each party is awarded the vehicles titled in their name alone.DIsc. Husband is awarded: _

D 15D. Wife is awarded: -'--- _

!XI15E. Necessary transfer documents shall be signed no later than ten days following the filing ofthis Divorce Decree. Ifeitherparty fails to do so, the Director ofFinance ofthe City and County ofHonolulu is authorized and directed to transfer theownership ofvehicle(s) if requested to do so.

FORM NO. 073106 8/98(Page 3)

DIVORCE DEC~EE (WITH CHILDREN) 1F..p.o96

16. Real Property:o16A. Neither party owns any interest of any kind in any real property.o 16B. The real property shall be divided as follows: _

17. Life Insurance:017A. There is none.o 17B. Each party is awarded the life insurance policy(ies) now held on hislher life, together with any cash value therein and

subject to any debt thereon.o 17C. The life insurance shall be divided as follows:-------------------

18. Retirement AccountslBenefits:o18A. There are none.o 18B. Each party shall keep their own.o 18C. The retirement accountslbenefits of the parties shall be divided as follows: _

19. All Other Assets (Personal Belongings, Furniture. Household Effects, Art, Stamps, Coins, Tools, Equipment, Jewelry, AccountsReceivable, Investment Assets, Business Assets, Cemetary Plots or Niches, Tax Refunds Due, etc.):o19A. Each party is awarded the personal belongings and the household effects in hislher possession.o 19B. Husband is awarded: _

o 19C. Wife is awarded: _

20. All Outstanding Debts:D20A. Each party shall pay all of the credit card and other debt, if any, now in hislher name alone.D20B. There are no joint debts.D20C. Husband shall pay: _

D20D. Wife shall pay: _

21. Name Change:D2IA. Wife shall resume the use of her 0 birth surname 0 former married name and shall be known hereafter as

(first, middle, last name)

D2IB. Husband shall resume the use of his 0 birth surname 0 former married name and shall be known hereafter as(first, middle, last name)

22. 0 There is a supplemental order filed concurrently with this Divorce Decree.

FORM NO. 073106 8/98(Page 4)

DIVORCE DECREE (WITH CHIL.DREN) 1F·P-096

23.0 Failure of Party to Perform: If either party fails toexecute any document in compliance with this decree, the other partymay submit a motion to the Court, requesting that the Court appoint the ChiefClerk ofthe Court to execute said document onbehalfofthe non-compliantparty. Said motion may be done without further notice to the non-compliantparty. Such executionby the Chief Clerk shall have the same effect as if executed by the non-compliant party.

24. Other:

Date Judge

APPROVED AS TO FORM AND CONTENT:

X XSignature at Plalnlitt signature of Defendant

SS#: SS#

Address: Address:

Employer's Name and Address: Employer's Name and Address:

Date Plaintiff Signed Decree: Date Defendant Signed Decree:

APPROVED AS TO FORM:

X Xsignature of Attorney for Plalnlitt Signature of Attorney for Defendant

Name: Name:

FORM NO. 073106 8/98(Page 5)

DIVORCE DECREE (WITH CHILDREN) 1F·P-096

STATE OF HAWAI'IFAMILY COURTFIRST CIRCUIT

ORDER FORINCOME WITHHOLDING

CASE NUMBER

FC-D NO.

VS.

Preparer's Name, Address and Telephone Number

PLAINTIFF,

DEFENDANT.

Hearing Date:Judge:Date Support Order Filed:

TO THE EMPLOYER OR SUCCESSOR EMPLOYER OF:

Employee/Obligor:Address:Social Security Number:

IT IS HEREBY ORDERED that:

I. Pursuant to Hawai'i Revised Statutes (HRS) §§ 571-52.2 and 52.3, the employer or successor employer shall:

A. Withhold from any salary, wages or any entitlement ofmoney payable to the above employee/obligor, the amountof $ per month. The amount to be withheld may be apportioned from each pay period in themonth. The withholding, including a $2.00 administrative fee charged to the employee/obligor, shall not exceedthe maximum permitted by section 303(b) Consumer Credit Protection Act (15 USC I673(b»;

B. Begin withholding the above amount no later than the first pay period within seven (7) days after a certified copyofthis order is mailed to the employer.

C. Deliver the withheld amount payable to the Child Support Enforcement Agency (CSEA), P.O. Box 1860,Honolulu, Hawai'i 96805-1860 no later than five (5) business days after the employee/obligor has been paid. Ifemployer is ordered to withhold amounts for more than one employee/obligor, the total withholdings may be paidin one check with a list of amounts applicable to each employee/obligor by case number, name and social securitynumber.

II. The employer is notified that:

A. It may charge the employee/obligor a $2.00 administrative fee for each payment made to CSEA. Said fee shall notbe deducted from the amount paid the CSEA (HRS §571-52.2(f);

B. This withholding order has priority over any other garnishment, attachment, execution or assignment and is notsubject to exemptions or restriction sunder HRS Chapter 651, 652 and 653 (HRS §571-52.2(f);

C. It is unlawful for an employer to ignore this order. Failure to comply with this orderwill result in the employer being responsible for the full amount ordered to bewithheld (HRS §571-52.2(g»;

D. It is a crime for an employer to refuse to hire, discharge or discipline a (prospective)employee/obligor due in any part to this order. (HRS §§571-52(c), 71O-1077(l)(g),706-640, and 706-663. Penalties include imprisonment and fines.

REVISED 2199 ORDER FOR INCOME WITHHOLDING

STATE OF HAWAI'I STATEMENT OF MAILING CASE NUMBER

FAMILY COURT EXHIBITS "1" AND "2"FIRST CIRCUIT (Re: Order for Income Withholding) FC-D NO.

This document is prepared byo Plaintiff 0 Atty. for Plaintiff

PLAINTIFF(Full Name) Name

VS.Address

DEFENDANTCity, State. Zip

(Full Name) Phone

STATEMENT OF MAILING

I REPRESENT THAT I caused one certified copy ofthe Order for Income Withholding to be mailed by certifiedor registered mail, return receipt requested to:

elidd Support Payor's Employer

Employer s Address

CItylStateJlZlp

At the time of mailing, the receipt attached hereto as Exhibit "1" was postmarked and dated. Thereafter, thereturn receipt attached as Exhibit "2" was received.

DATE PLAINTIFF'S SIGNATURE

11/98 STATEMENT OF MAILING/EXHIBITS "1" AND "2"1F.p-3XX

EXHIBIT "1" EXHIBIT "2"